Does My Baby Have a Tongue Tie? - how to check for tongue ties and get support for your baby in Toronto
What is a Tongue Tie (a.k.a Ankyloglossia)?
If you look in any baby’s mouth you will notice a piece of tissue called a frenulum. You’ll notice a band of tissue that connects the tongue to the floor of the mouth, called a lingual frenulum and a band of tissue that connects the lip to the upper gums, called a labial frenulum.
Sometimes these tissues are tight and restrictive.
Babies generally need good motion in their tongues to help them feed effectively. Based on incredible ultrasound analysis, we now know that the tips of their tongues grip to the breast or bottle and the back of the tongue moves like a wave motion, while they breastfeed and bottle feed.
If the tissue is so tight and restrictive, it may impact how the tongue moves and how a baby is feeding.
Here’s the basic equation on deeming if a lingual frenulum is a tongue tie:
Tight tissue + restricted tongue mobility + feeding issues (that cannot be resolved with skilled lactation support) = tongue tie
Features of a Tongue Tie
Babies with tongue ties will often display certain behaviours during their feeds. Generally, babies with tongue tightness do better with bottles than breastfeeding. That’s because bottles are more controllable - we can adapt the flow rate a lot easier!
However, I’ve seen many, many babies with tongue ties show symptoms with BOTH breastfeeding and bottle feeding.
Here’s some symptoms, of tongue ties, that we see consistently:
Leaking from the sides of the mouth, while actively drinking
Consistent clicking noises or other loss of suction noises
Coughing and gagging, with troubles handling letdowns
Maternal nipple pain and nipple damage
Slow weight gain
Inability to get full with breast feeding, despite great milk supply
Consistent sleepiness during feeds
Fussiness with feeding
Taking in excess air while feeding
The BTAT Tabby is one of the best tongue tie assessment tools currently available.
Tools to Check for a Tongue Tie
There are many evidence based and well tested tools out there, that are used to screen for tongue ties. Unfortunately, none of them are perfect.
Feeding a baby is so multi-factorial. Using an evidence based screening tool (or multiple), alongside watching and supporting the baby’s feeding, by a lactation consultant, is currently the highest standard assessment method.
Remember - just because we see tissue does not mean that there is a tongue tie. We need to look at the physical appearance of the tongue, its mobility (how it moves up, side to side and out of the mouth, how it suctions), and how the baby is feeding.
Current available screening tools include:
BTAT Tabby. The BTAT is a visual assessment tool that looks at the attachment of the frenulum to the base of the tongue and the floor of the mouth. It also looks at the function of the tongue, and how it moves up and out. 8 is a perfect score and under 5 suggests tongue tightness.
Coryllos. This tool looks at where the frenulum attaches to the underside of the tongue and where it hits the floor of the mouth. Type 1 is the tightest tongue and Type 4 is a tongue with more mobility.
Kotlow. This tool looks at where the frenulum attaches to the underside of the tongue and where it hits the floor of the mouth. Type 4 is the tightest tongue and Type 1 is a tongue with more mobility.
Hazelbaker. This tool is a more complex tool that grades the appearance and function of the tongue. Over 14 is a perfect score and under 11 suggests tightness.
Martinelli. This tool looks at the appearance and movement of the tongue. It also looks at the attachment of the frenulum to the floor of the mouth and where it attaches on the tongue.
Interesting fact - current research shows that between 2-20% of babies have tongue ties. The range is so high because studies are limited and there is no standardized way to assess for a tongue tie.
Support for Babies with Tongue Ties
Seeking skilled, realistic and compassionate care is key to supporting babies, and their families, when there is suspected tongue tightness. It’s ideal if you’re able to see a multi-disciplinary team, including a doctor trained in pediatrics and tongue ties, alongside a lactation consultant.
After your thorough assessment, you will make a decision on whether to pursue a tongue tie release (also known as a frenotomy or frenulectomy) or not. It’s important that you have all the information and that you are offered options - there are always options!
Come see us at Kindercare Pediatrics! Myself (Kate Sissons, IBCLC) and my colleague , Alex Thompson, IBCLC, work alongside two experienced pediatricians. We are a team of specialists, in Toronto, with over a decades’ worth of experience, diagnosing and supporting babies with tongue ties. We provide a very thorough assessment and we also provide families with the option of a tongue tie release - frenotomy, should they choose to pursue one. Reach out for more information here.
Some people choose to seek out additional care (such as body work or oral suck training), to support their babies with oral restrictions. We can counsel you on these options, should you want to explore them.
Interesting fact - current research shows that slightly more boys, than girls have tongue ties.
Other Oral Restrictions (a.ka. tethered oral tissues or TOTs)- lip and cheek ties
The current evidence shows that tongue ties are the main areas of tightness that impact feeding, for babies. Lip (labial) and cheek (bucchal) ties are sometimes released.
There is no evidence to currently support releasing cheek ties.
With lip ties, we watch how the lip flanges out with an exam, while the baby is not latched and when the baby is latched. We also pay attention to where pain and damage is happening. Tight labial frenulums, lips that curl in, with pain and/or damage on the areola, can signify a lip tie.
Interesting fact - current research shows that there may be a genetic link to tongue ties. If you or someone in your family has a tongue tie, the chances are higher that your baby will have one too.
What about a tongue tie release?
Making the choice to pursue a tongue tie release is not an easy one. There’s a lot to consider.
Within my practice, I want people to feel like they have ALL the information and that they feel completely confident and comfortable with their decision. A tongue tie release is a minor procedure, but it’s still a procedure.
I’d suggest checking out this post here to learn more about the ins and outs of what a tongue tie release involves, including the various methods (i.e. laser frenotomy vs scissor frenotomy), the best age to perform a tongue tie release, and the up to date evidence on post release exercises and care.
Please reach out to me directly, if you’re looking for lactation and infant feeding support or if you have questions about your baby’s suspected tongue tightness.
Kate is an IBCLC, working across the city of Toronto. She provides support to families, privately, in their homes. She also works with new parents and their babies out of a Pediatric Clinic (Kindercare Pediatrics).
The lactation and infant feeding clinic supports all types of feeding, and includes a thorough assessment of oral anatomy and tongue ties. Tongue tie releases can be performed at this clinic. Get in touch to learn more.
